Nearly half of the 37.2 million HIV-positive adults ages 15 to 49 worldwide are women, and the number of HIV-positive women in all regions of the world has been increasing over the past two years, according to a report released on Tuesday by UNAIDS and the World Health Organization in advance of World AIDS Day on Dec. 1, Reuters/USA Today reports (Reaney, Reuters/USA Today, 11/24). According to the report, titled "AIDS Epidemic Update 2004 (also available in PDF)," the total number of HIV-positive people in the world has risen from 38.1 million in 2003 to 39.4 million in 2004, according to the New York Times (Altman, New York Times, 11/24). More than three million people worldwide have died from AIDS-related illnesses in the past year, according to the Los Angeles Times (Mestel, Los Angeles Times, 11/24). Over the past two years, the number of HIV-positive women in East Asia increased 56%, the largest increase in any region, according to the New York Times. In both Eastern Europe and Central Asia, the number of HIV/AIDS cases among women increased 48%, according to the report. In Africa -- the continent most-heavily affected by the disease -- women represent nearly 60% of HIV-positive people (New York Times, 11/24). In sub-Saharan Africa, where about 70% of the world's HIV-positive people live, about 75% of HIV-positive individuals ages 15 to 24 are women, according to the Boston Globe (Donnelly, Boston Globe, 11/24).

Reasons for Increases Among Women
According to the report, several factors are responsible for the increases in the number of HIV/AIDS cases among women, BBC News reports. One factor is that women are more biologically susceptible to contracting HIV than men. Male-to-female HIV transmission is twice as likely to occur as female-to-male transmission during vaginal intercourse, according to BBC News (BBC News, 11/23). In addition, women face many inequalities that pose a "major obstacle" to fighting the disease, according to the AP/Detroit Free Press (Ross, AP/Detroit Free Press, 11/24). UNAIDS Executive Director Peter Piot said that HIV/AIDS prevention programs in developing countries can be ineffective among women because women face poverty, sexual violence, limited educational opportunities and unequal access to medications, according to the Wall Street Journal (Chase, Wall Street Journal, 11/24). Prevention programs that advocate sexual abstinence until marriage, monogamy and condom use are ineffective for women in developing countries who "don't have the power to say 'no' to sex or to insist on condom use," according to the AP/Free Press. UNAIDS Deputy Director Kathleen Cravero said the agency has found that women and girls in most regions of the world "simply do not have the economic and social power or choices or control over their lives to put that information into practice" (AP/Detroit Free Press, 11/24).

Putting Women "At the Heart" of Response
UNAIDS Senior Adviser Karen Stanecki said that a "female-centered strategy must be at the heart of efforts to fight AIDS" (Tasker, Miami Herald, 11/24). The report says that "cultural change is the only way" to fight the disease in developing countries, where women have "no status or power," according to London's Guardian (Boseley, Guardian, 11/24). "We are touching on some of the deepest, most profound societal norms that are driving this epidemic," Piot said, adding, "AIDS is a disease, but it cannot be approached solely as a public health challenge. We have to go deeper and change societal norms" (Picard, Globe and Mail, 11/24). "We need to give women power to reduce levels of violence against them and to protect their property and inheritance rights," Cravero said, adding, "We are still not keeping pace with the epidemic, and we need to tackle the problem in women" (Laurance, Independent, 11/24).

Diverse Epidemics
However, Stanecki said that although the global HIV/AIDS numbers are "sobering," it is important to note that "there is no single AIDS epidemic; there are many," according to Toronto's Globe and Mail (Globe and Mail, 11/24). Some regions' epidemics still are in the early stages, according to a UNAIDS/WHO release (UNAIDS/WHO release, 11/23). "In some regions, it is mainly injecting drug use that drives it -- that would be true for Eastern Europe and much of East Asia," Peter Ghys, manager of the epidemic and impact monitoring team for UNAIDS, said, adding that the differing epidemics are "stretching resources" and making prevention strategies "tricky to target" (Fak, Financial Times, 11/24). A "common and troubling" challenge is that some countries "often" misdirect resources to fight the epidemics, according to the New York Times. For example, prevention programs might target men who have sex with men and exclude women, or vice versa, or ignore the problem of injection drug use, the New York Times reports (New York Times, 11/24). "These latest trends firmly establish AIDS as a unique development challenge," Piot said, adding, "The time of quick fixes and emergency responses is over. We have to balance the emergency nature of the crisis with the need for sustainable solutions" (UNAIDS/WHO release, 11/23).

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Funding
The report said that there has been a "sea change" in the amount of money being spent to combat HIV/AIDS in developing countries over the past few years, according to the Washington Post. The total amount spent to battle the disease in developing countries increased from $2.1 billion in 2001 to $6.1 billion in 2004, with half of the money raised this year coming from developing countries and the other half coming from donor countries and organizations, the Post reports (Brown, Washington Post, 11/24). However, Piot said that the level of funding still "falls short" of the $10 billion needed annually to fight HIV/AIDS in developing countries, according to the San Francisco Chronicle. "The key challenge is to make that money work," Piot said. Most of the money spent this year to fight HIV/AIDS in developing countries has been used to train medical personnel and establish antiretroviral drug delivery systems, according to the Chronicle. "We'll see the impact of that in the next few years," Piot said (Russell, San Francisco Chronicle, 11/24).

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